Non-Surgical Resolution of Cerebrospinal Fluid Fistula Caused by Nasal Swab for COVID-19 Diagnosis. A Case Report

Abstract

Nasal swab tests have been extensively utilized for the diagnosis and prevention of the spread of pandemic coronavirus infection (COVID-19). Although deemed a safe and well-tolerated procedure, serious complications have been reported in its administration. This paper presents the case of a 36-year-old patient who experienced continuous watery rhinorrhea from the right nostril five days following a COVID-19 nasal swab. A diagnostic suspicion of cerebrospinal fluid (CSF) fistula was established six weeks after the onset of rhinorrhea, which was initially misinterpreted as allergic rhinitis. Rhinoendoscopic and radiological findings failed to conclusively identify a fistulous defect at the skull base, but the detection of β-2 transferrin in the nasal fluid confirmed the presence of CSF. Following medical treatment, the CSF rhinorrhea progressively decreased until resolution, with no recurrence over a one-year follow-up period. Nasal swab tests for COVID-19, while considered safe, are not without risks. The reported case demonstrated a severe intracranial injury that, despite late diagnosis, was manageable with the implemented medical treatment.

Keywords

• covid-19 serological testing
• cerebrospinal fluid
• rhinorrhea